Search

Background: Central nervous system (CNS) tumors are the most common solid malignancies in children worldwide, including in Armenia. The current study aims to analyze epidemiological data, treatment, and outcomes of children and young adults (≤25 years) with CNS tumors in Armenia during the last 26 years. Methods: We collected data from pediatric and young adult patients treated in selected sites in Armenia from 1 January 1995 to 31 December 2020. Incidence by sex, age at diagnosis, time from first complaints to diagnosis, histopathology results, treatment strategies, complications, and overall survival (OS) rates were calculated. Results: The multicenter data analysis revealed 149 patients with diagnosed primary CNS tumors over 26 years. Among them, 84 (56.4%) were male. The median age at diagnosis was 7 years (range, 3 months to 25 years), and the median time from the first complaints to diagnosis was 2 months (range, 1 week to 70 months). Medulloblastomas and other embryonal tumors (47), low-grade gliomas (32), and high-grade gliomas (22) were the most commonly diagnosed malignancies. Ependymomas, craniopharyngiomas, germ cell tumors, and other malignancies were observed in 22 patients. For 26 patients, no histopathological or radiological diagnosis was available. Follow-up information was available for 98 (65.8%) patients. The 5-year OS rate for the whole study group was 67.7%. Conclusion: Consistent with international data, embryonal tumors, and gliomas were the most commonly diagnosed CNS malignancies in Armenia. Multimodal treatment was often not available in Armenia during the study period, especially for early cases.

For many years, it was generally accepted that melatonin and somatostatin have intracerebral sources of synthesis. Melatonin is produced in the pineal gland and somatostatin in the hypothalamus. However, there are very informative data regarding the extracerebral sources of melatonin and somatostatin synthesis in numerous literary sources published over the past 60 years. At the same time, the biological purpose of extracerebral somatostatin and melatonin has been insufficiently studied. This article presents the readers with an analysis of modern literature and the results of own researches on the biological role of melatonin and somatostatin produced in the pancreas and intestinal tract. Under experimental conditions on arginine-induced acute pancreatitis model in rats, structural and hormonal changes were studied in the pancreas, mucosa of the small and large intestines in regional pathological process using morphological, morphometric, immunomorphological and enzyme immunoassay methods. According to the morphological and morphometric analysis results, gross dystrophic changes in the pancreas and intestinal mucosa were observed at relatively early stages of the pathological process – in 2 and 24 hours after the arginine administration. Immunomorphological studies established that the content of melatonin-positive secretory cells noticeably decreased, especially in the areas of mucosal damage in this very period of the pathological process in pancreas, in the mucous membrane of the small and large intestines. At the same time, the content of somatotropin in blood serum and pancreas markedly increased during the indicated period of the experiment. Severe dystrophic processes on small intestinal mucosa, which are particularly expressed by inhibition of local melatonin-secreting cell function, apparently exclude the inhibitory effect of melatonin on somatostatin synthesis process in pancreas. It is not excluded that there is a directed activation of pancreatic delta cells responsible for the somatostatin synthesis at relatively early stages of “arginine pancreatitis”. Based on our own researches in context with available very informative literature data, we can conclude that extrapineal melatonin and extrahypothalamic somatostatin should be given an important role in the integrative activity of organ-digestive system – the pancreas and small intestine.

Polyamines (putrescine, spermidine and spermine) as well as γ- and α-synucleins are currently the subject of a special comprehensive study due to their direct influence on the formation of neoplastic processes. This review article presents informative data on the role of aliphatic polyamines (putrescine, spermidine, spermine) in the induction of a number of oncological diseases with their localization in the digestive and urinary systems. Aspects related to the synthesis and aggregation of γ-synucleins into malignantly reborn cells have been discussed. The article provides information on the possible prevention of further growth of malignant cells, by inhibiting enzymatic processes responsible for the polyamine synthesis. In case of prolonged persistence of Helicobacter Pylori in the stomach, an enhanced synthesis of polyamines and cumulation in situ of oligo- and aggregated gamma synucleins occurs in mucous membrane cells. It is possible that all of the abovementioned factors in total directly and/or indirectly have a stimulating effect on the processes of the malignancy of gastric mucosal cells. The subject of special discussion was the latest literature data, according to which, under the conditions of Helicobacter Pylori persistence in the digestive tract organs, in the gastric mucosal cells an enhanced synthesis of putrescine occurs, high concentrations of which can have a co-carcinogenic effect on normally functioning target cells. From a qualitatively new point of view, the fact of cumulation in malignantly reborn cells of an aggregated gamma synuclein, which was found during Helicobacter Pylori infection, should be considered.

Aim Necrotising enterocolitis (NEC) is still a disease with high morbidity and mortality. The aim of the study was to analyse retrospectively whether the introduction of a multi‐modal three‐component enteral medication regimen resulted in a change in morbidity and mortality in neonates with NEC. Methods When diagnosis of NEC was established, the following multi‐modal three‐component enteral medication regimen was administered enterally (via nasogastric tube): an antibiotic, an antifungal agent and a probiotic. The primary outcome parameters were intestinal perforation, surgical interventions and mortality during the observational periods. Results In the study period, 2212 patients were admitted to the NICU, out of which 200 (9%) developed NEC. Significantly fewer infants died in the Intervention Group (13 of 104 infants, 13%) compared to the Control Group (38 of 96 infants, 40%) (P = .0001). No infant in the Intervention Group (0%) presented with an intestinal perforation, as compared to 15 infants (16%) within the Control Group (P = .0001). In the Control Group, 21 infants (22%) needed surgical intervention, whereas 0 (0%) infants needed this in the Intervention Group. Conclusion The introduction of an enteral multi‐modal three‐component medication regimen resulted in a significant reduction of mortality and of need for surgical intervention in infants suffering from NEC.

ObjectiveThe aim of this study was to perform a retrospective analysis of the prevalence, etiologies, and types of maxillofacial injuries (MFI) and sites of maxillofacial fractures (MFF) and their management in the Department of ENT and Maxillofacial Surgery of <> No. 1 University Hospital in Yerevan, Armenia.Material and methodsA retrospective cross-sectional study was conducted. Data including age, sex, date of referral, mode of injury, etiology, radiology records and treatment methods were extracted. Study outcomes were measured using percentages, means, standard deviations and tests of proportions. P ResultsA total of 204 patients had a mean age of 36.26 ±1.08 years (156 males and 48 females), and a total of 259 MFIs were recorded between 2017 and 2020. Interpersonal violence was found to be the most common etiology of MFFs in this study (42.1%), followed by road traffic accidents (RTAs) (27.9%) and falls (18.6%). The nasal bone was the most common injury site (47.5%), followed by the mandible (31.4%) and zygomatic complex (11.7%). The most common fracture site was the mandibular angle (37.9%), followed by the symphysis/parasymphysis (28.1%) and body (12.6%). The majority of MFFs were treated by open reduction and internal fixation.ConclusionInterpersonal violence, followed by RTAs and falls, was the most common cause of MFIs. The nasal bone was the most common injury site, followed by the mandible and zygomatic complex. Social education with the objective of reducing aggression and interpersonal conflict should be improved, and appropriate RTA prevention strategies should be strengthened and implemented.KEY MESSAGESWhat is already known on this subjectTraumatic injuries continue to be important causes of morbidity and mortality in both developed and developing countries.The incidence rates, etiologies, types, and injuries associated with MFFs vary among different countries.RTAs are the most frequent cause of MFIs in developing countries, and in contrast, the most frequent cause of MFFs in developed countries is IV or assaultWhat this study addsInterpersonal violence was found to be the most common etiology of MFF in this study, followed by RTAs and falls.Patients aged 21-30 years were likely to have sustained nasal bone fractures and mandible fractures in equal proportions.The nasal bones were found to be the most common injury site, followed by the mandible and zygomatic complex.

Background:According to statistical studies, about 3.6 million Americans miss medical appointments each year because of difficulties with transportation to a healthcare facility, and the impact of missed primary care appointments is estimated at billions of dollars annually. The access of the patient to necessary services is restricted and the role and functions of a medical doctor as responsible key decision maker is significantly diminished. Key responsibilities are still on the shoulders of the medical doctor, but decision-making power is shifted to middleman administrative bodies. This split between the responsibilities and decision-making bodies is destructive for the service of medicine. The aim of this study is to create a new management model in the health care system.Methods: To develop a new model of management in the health care system, we conducted a blind survey among 1,700 patients. To optimize the health care system, a decentralization health careservice method is proposed via uberization.Results: The method may continue with providing the request to a responding healthcare provider and receiving a response from the responding healthcare provider. The method may continue with establishing a bidirectional communication between the patient and the responding healthcare provider in real-time and receiving a plan of actions to treat the patient from the responding healthcare provider. The method may continue with receiving, from the diagnostic and laboratory service, the real-time vital parameters of the patient and making the real-time vital parameters available to the patient and the responding healthcare provider in an electronic medical record database.Conclusion: On the basis of our developed model of decentralization of the healthcare system via uberization, the implementation of the proposed model will increase the efficiency and availability of medical services.

The comprehension of a long-term humoral immune response against the SARS-CoV-2 virus can shed light on the treatment and vaccination of the disease, improve the control of the pandemic infection. We assessed the antibodies against SARS-CoV-2 nucleocapsid (N) protein in 1441 COVID-19 convalescent patients within 15 months longitudinal nationwide multicenter study from middle-developed country. 92.7 % of convalescent patients’ serum contained antibodies against N protein and only 1.3% of patients had a delayed antibody response. In the majority of convalescent patients’ the durability of antibodies lasted more than one year. The kinetics of neutralizing antibodies took a bell-shaped character – increased first 25-30 weeks, then started to decrease, but were still detectable for more than 15 months. Summing up, we found that anti-SARS-CoV-2 humoral response levels, in particular the level of peak antibodies, correlate with age, older patients developing more robust humoral response independently from sex, disease severity and BMI.

Cutaneous ureterostomy is a well-established surgical technique of incontinent urinary diversion treatment. However, stoma stenosis limits widespread utilization of this technique. We present our modification of constructing single-site tubeless cutaneous ureterostomy aiming to reduce stomal complications and improve catheter-free rate of those patients. In 2016–2017, 30 patients with 60 renal units underwent modified and 30 patients with 60 renal units standard technique. The main differences of our method from previously described techniques were the preservation of parietal peritoneum and fixation of ureteral orifices one to another. Catheter-free rate was calculated in all patients with a minimum follow-up period of 12 months. In total, 52 patients, 26 from the modified cutaneous ureterostomy group, and 26 from the standard cutaneous ureterostomy group were available for the final analysis. The patients’ mean age was 63.1 years. The median follow-up period was 25.8 months (ranging from 1–37 months). The catheter-free rate was achieved 76.9% (20 patients) in the modified group compared to 42.3% (11 patients) in the standard group (P value = 0.013). No statistically significant differences were observed between two groups for late complications and readmission rates. Our technique of single-site-modified cutaneous ureterostomy is a safe and simple surgical technique with similar postoperative complications rate and better catheter-free rate compared to standard cutaneous ureterostomy. We believe that this technique could be a method of choice not only for candidates for cutaneous ureterostomy but also for selected patients for ileal conduit.

Background: One of the main contributors in low survival rate in LMIC is the lack of availability of cancer medications for curative, supportive and palliative care. In many developing countries access to cytotoxic medicine is a major challenge. The information about the availability of essential medicines for pediatric cancer in the country is not known. The main objective of this study was to determine whether the medications used during the treatment of pediatric cancer are available in Armenia. Methods: In summer 2016 we conducted a survey in the 3 main pharmacies in Yerevan, which import pediatric cancer medications to Armenia to evaluate whether medications used during cancer treatment are officially registered and available in the country. In addition, the information on official registration was cross-checked with the Ministry of Health of the Republic of Armenia (MOH). Simultaneously, detailed information about the drugs, on type of produced drug company, doses and price intervals was confined from the price lists of the national drug importer companies. Results: The survey included 64 agents in three classes of medication: anti-neoplastics, anti-microbials, and drugs used in supportive care. All of these medications were included in the recent version of the WHO model list of essential medicines. From 30 anti-neoplastic medications on the essential medicines list 22 (73%) were officially registered in Armenia; from 19 anti-microbial drugs all were registered except caspofungin and from 15 supportive care agents 13 (87%) were registered. From registered anti-neoplastic drugs 18% and from antimicrobial drugs 33% were not available in the drug stores. Conclusion: This study showed that not all the drugs from the SIOP PODC Essential Medication list for pediatric oncology are officially registered and available in Armenia, and effective drug regulation focusing on the childhood cancer care medicine is needed for improving the situation in the country.

Background: Tracheostomy is one of the more commonly performed procedures in critically ill patients. Postoperative scarring is one of the bothersome sequelae of tracheostomies. Scars distorted the physical appearance, especially when found on the head and neck, which could cause a negative impact on quality of life. The aim of this study was to evaluate and assess the impact on quality of life of post-tracheostomy`s scars, depending on the method of tracheostomy.Methods: The prospective, single-center observational case-control study was conducted. One hundred and fifty-six persons with more than four months of post-tracheostomy surgical scars presence were observed using the Patient and Observer Scar Assessment Scale and Dermatology Life Quality index questionnaire. Persons were divided on two groups depending on method of performed tracheostomy, and duration of cannulated period was considered in both groups. Statistical analyses were performed by using SPSS ver. 16.0 (SPSS Inc., Chicago, IL, USA) and p-values of Results: The patients who had a tracheostomic tube cannulation period of less than 15 days had better cosmetic results than those who had tracheostomic tubes for more than 15 days, regardless of the method of tracheostomy 6.64± 0.082 vs. 16.15± 0.096 (pConclusions: Aesthetic outcomes of post-tracheostomy`s scars after the open surgical tracheostomy technique, performed using a minimally invasive approach, did not statistically differ from those of the percutaneous dilatational technique. Persons with a long duration of tracheostomic tube ventilation showed worse aesthetic outcomes compared with short-term tracheostomic cannulation, not dependent on the tracheostomy performing technique.The Dermatology Life Quality index have shown that post-tracheostomy`s scarring in the presented study had no effect on the person's quality of life.Trial registration: ISRCTN24668317 (IRB no.YSMU №7/18-19). Date of registration 23/04/2019

Salbutamol being a beta-adrenergic stimulator may increase heart rate and the potential for cardiac arrhythmias & Ipratropium bromide cause ACh released by these fibers binds to muscarinic receptors in the cardiac muscle, at the SA and AV nodes that have a large amount of vagal innervation and ACh released by vagus nerve binds to M2 muscarinic receptors, a subclass of cholinergic receptors which produces negative chronotropy & dromotropy in the heart, as well as negative inotropy and lusitropy in the atria. The effect of above mentioned drugs was noted in patients with COPD and CVS ailments in 2 groups of same age & equal sex distribution. Age bar of being 65-70 years. In this study, ECGs were evaluated before and after the usage of salbutamol and ipratropium bromide. Patients were evaluated before and after 4 weeks of treatment :1) salbutamol, 90 mcg 1 puffs every 4 hours 2) Ipratropium Bromide, 34 mcg 2 puffs every 6 hours. ECGs performed pre-treatment and at 4th Week. We were able to find various arrhythmias such as atrial tachycardia, atrial fibrillation and ventricular tachycardia. 60 ECGs recordings in 30 treated patients (M=F). Out of 30 patients, ECG changes recorded in 28 patients. The most common met ECG was with atrial tachycardia in 20 patients out of which 12 were females (60%) and 8 were males (40%). The least seen was atrial fibrillation in only one male patient. The ventricular tachycardia was seen in 6 males and 1 female patient. The percentage of patients with atrial tachycardia, post usage of the drugs mentioned was significantly higher with 71.4%, which is way higher than other types of arrhythmias occurred 3.57%(AF), 25%(VT) respectively.

Background Chemotherapy-induced thrombocytopenia (CIT) is a significant complication of cancer therapy. Data on the optimal management approaches of this morbidity in children and young adults are still limited. Aim The aim of the study is to estimate the frequency and severity of CIT and associated clinically significant bleeding in children and young adults with solid tumours and haematologic malignancies. Methods For this retrospective, hospital-based study, children (0–18 y) and young adults (19–40 y) with different types of solid tumours and haematologic malignancies who received chemotherapy at the Muratsan Hospital Complex of Yerevan State Medical University were identified from the patients’ database and included in the study (overall 122 patients). Thrombocytopenia was defined as a decrease of platelet count below

We performed a literature review to examine barriers for rhabdomyosarcoma treatment in low-resource settings, and identified 29 articles from 14 middle-income countries, with none from low-income countries. Notable findings included inconsistent use of local control modalities, lack of diagnostics in some settings, and high rate of abandonment specifically in low middle-income countries. Reported limitations included lack of surgical expertise and/or radiation therapy, advanced stage of disease, and absence of health insurance. Although very poor outcomes were prevalent in several settings, good outcomes were achievable in others when multidisciplinary therapy and financial coverage of medical care were made available.